Thursday 27 January 2011

Imposing choices

Barbara Kay argues badly in favour of infant circumcision:
Passing to the moral realm, the argument of “informed consent” is easily demolished by the fact that we routinely vaccinate our children against disease without their consent for their own good. Even before we knew of the HIV connection, amongst those circumcising their sons, health and hygiene were always the reason. STDs are much more common in uncircumcised men, and circumcision causes a 12-fold reduction in the incidence of urinary tract infections. Complications from circumcisions performed by experienced surgeons and mohels are as rare as those springing from dental procedures or vaccinations: that’s to say, statistically negligible.

On to the pernicious myth that male circumcision, a 30-second procedure, is a “mutilation” and the obscene canard that it is the equivalent of sexist FGM. FGM is a horribly protracted and painful cutting of girls under terrifying circumstances...

“Mutilation” is a disgusting word to apply to the excision of a non-essential bacteria trap, nearly painless and instantly forgotten (those who claim otherwise are fantasizing; no credible study demonstrates lasting effects)....

Set aside the rights-based rhetoric. It’s about sex: Circumcised men have greater pre-orgasmic endurance; non-circumcision permits more frequent ejaculations. What matters most to the anti-circumcision activists is their diminished pleasure with frequently changing sexual partners, as befits an era where the number of conquests is a more common metric of romantic success than long-term relationships. Our legislators have better things to worry about than this.
Let's construct a reasonable argument from the hash she's made of things above. But let's not avoid smacking Kay around a bit first. The vaccination analogy fails utterly as the main health benefits of circumcision come after the individual is old enough to make that choice himself. Second, in a counterfactual world in which female circumcision were done under medical anaesthetised conditions and offered minor health benefits (slightly reduced risk of various problems), would Kay recommend it? We can easily imagine a gender reversing of her final paragraph that would make its obnoxiousness a little clearer. Fewer utils is a cost, not a benefit.

Here's the more reasonable form of the argument. Medical procedure X correlates with certain health benefits but also with reduced capacity for enjoyment. If it's undertaken before the individual is capable of making choices, the short term costs of the procedure are relatively low; if it's done after the individual is capable of making choices, the short term costs are much higher (more traumatic, longer recovery time). The long term costs and benefits are identical. If the short term costs are high enough and if the parent thinks it likely that the child's eventual optimization would result in his choosing the procedure, it's best for the parent to impose X. So imagine that removing a kid's tonsils in infancy were simple and painless, that doing it after age 12 were horribly painful, and that half of all adults who hadn't had their tonsils removed would get a tonsil infection with high mortality rates. Would I impose a tonsillectomy on my kids in infancy? You betcha. And I'd expect them to thank me for it. Would I agree with a procedure that would dull the kids' enjoyment of food (say excising half the taste-buds) if it correlated with reduced obesity and diabetes rates? Hell no.

In the case of circumcision, if you lived in a country where HIV rates were very high, access to condoms were difficult, sanitation were a problem, urinary tract infections were dangerous, and medical progress that would either reduce disease burden or reduce the costs of an adult undertaking circumcision were unlikely, then imposing that choice on your child might be optimal. If you're in a country where HIV is relatively rare, access to condoms is relatively easy, urinary infections are easily prevented through sanitation and fairly minor if contracted, then you're really infringing on autonomy by imposing that choice.

Kay's arguing against a proposed Canadian ban on infant circumcision. I'd also side against a ban. But not because the procedure's a great and wonderful thing; rather, because there are bounds within which violations of parental autonomy are worse than violations of the child's. This one's getting close to the border though.

Previously: Western symbolic forms of female circumcision that may prevent worse outcomes.

8 comments:

  1. This is another one of those subjects where libertarians will often disagree with one another. I think you did a good job of hitting all the major arguments.

    I wonder what the demographics of support for such a ban are? My guess is a sort of status-quo bias for men. I'd hypothesize that those who have their foreskins intact would favor the ban and those who had their foreskins removed favoring "a parent's right to choose".

    For women, I've only come across one that didn't favor circumcision (and she didn't have that strong of an opinion)... is this a self-serving bias?

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  2. Max: I'm guessing your sample is from the U.S. In countries like New Zealand, where most women will have encountered very few uncircumcised men (at least, up close), the attitudes of women are, I think, very different.

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  3. I wouldn't have data anywhere sufficient for answering those kinds of questions.

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  4. Whilst the rate of circumcision in NZ hit around 100% in the 1940-1950s, by the 1970s-1980s it had declined to around 25-30%.

    Which kind of implies that in the younger age groups, at least, women won't necessarily be unfamiliar with foreskins (so to speak)

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  5. And Barbara Kay should devote her efforts to ends more fruitful than gratuitious, misdirected and misinformed cynicism such as the following:

    "Set aside the rights-based rhetoric. It’s about sex: Circumcised men have greater pre-orgasmic endurance; non-circumcision permits more frequent ejaculations. What matters most to the anti-circumcision activists is their diminished pleasure with frequently changing sexual partners, as befits an era where the number of conquests is a more common metric of romantic success than long-term relationships. Our legislators have better things to worry about than this."

    Nobody knows whether men who retain all the moving parts Nature intended ejaculate more or less frequently than those who are pruned. Why does Kay think she knows the answer to this question?

    The routine circ debate in the USA has more and more become one about how it affects the quality of sex for both genders. Nevertheless, Kay's thinking remains wide of the mark. I suspect she has been faithful to her spouse for now several decades, by virtue of which she has been hors combat. Hence she has no basis for knowing better.

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  6. @Max: Supporters for a USA ban include many gay men, crunchy Moms, men who believe themselves damaged by the operation, and women who say they have trouble climaxing with cut dudes. Those opposed are a lot of cut men, and their parents and spouses.

    @Eric: doctors too should enjoy autonomy, namely professional autonomy. New Zealand doctors have been free to decline to snip, for several decades for sure and perhaps always. USA doctors act as if they are not free to refuse a mother's request, because maternity wards fear that a refusal will lead mothers to take their custom elsewhere. These facts are major unspoken drivers behind any proposed ban.

    @Duncan: the Crown stopped paying for it in 1969, whereupon the decline that began around 1960 accelerated. The rate reached zero sometime in the 1980s. The anti-circ movement (mostly a USA thing) points to New Zealand as an unambiguous triumph. But this triumph owed nothing to intactivist agitation, and everything to sensible teaching in NZ medical schools, and the professional autonomy of NZ doctors. The change was 100% doctor-led. And hence psychosexually uncontroversial. After all, doctors know best, don't they?

    @Seamus: a study published about 10 years ago in an Australasian medical journal, and based on a small sample of New Zealand women claiming experience with both kinds of men, reported that 88% of the women preferred the model with all the factory-installed parts. I have not read this study and do not know if it controlled for condom use.

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  7. And doing it infancy is NOT less painful or involve a shorter convalescence. Rather, the disutility of circumcising is more easily ignored by uninvolved parties when experienced in the first week of life as opposed to age 15 or 25. A newborn cannot speak, and has no awareness of the sexual realm. Hence he cannot formulate and express a cogent objection. Nice.

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  8. Just how many women have been in long term relationships with at least one partner of each kind? The opinion of women for whom this has not been the case, are not very valuable.

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